Physiotherapy During Pregnancy: Back Pain, Pelvic Girdle Pain and Staying Active

Back and pelvic pain during pregnancy is common — which is not the same as being something you simply have to put up with. Most of it responds to assessment, specific exercise and practical changes to daily movement.

Medically reviewed by Dr Afiya Sadiq, MPT
Last reviewed: 2 August 2026 · Our clinical team


Pelvic girdle pain is not the same as back pain

Pain felt at the front of the pelvis, in the buttocks, or spreading into the groin and thighs is usually pelvic girdle pain rather than ordinary low back pain. It is typically worse when the legs move independently — turning in bed, climbing stairs, getting out of a car, standing on one leg to dress.

The distinction matters because the management differs. Pelvic girdle pain responds to load management, specific muscle work and technique changes for the movements that provoke it.

Practical changes that usually help

Staying active

NICE antenatal care guidance supports keeping active in an uncomplicated pregnancy. Activity is usually adjusted rather than stopped: intensity that allows conversation, avoiding contact sports and activities with a fall risk, and taking care with prolonged lying flat on the back later in pregnancy.

Where a pregnancy has complications, activity advice must come from the obstetric team — general guidance does not apply to every pregnancy.

The pelvic floor during pregnancy

NICE guidance on pelvic floor dysfunction supports pelvic floor muscle training during pregnancy. The common error is doing the exercises without ever having the technique checked — a substantial proportion of people contract the wrong muscles, or bear down instead of lifting, and get no benefit from months of effort.

Leaking urine during pregnancy is common but is not something to accept as inevitable. It is assessable and usually treatable.

Symptoms that need urgent obstetric review — not physiotherapy

Contact your maternity unit immediately. These are not musculoskeletal problems.

What we do not claim

Physiotherapy does not manage the pregnancy itself and does not replace antenatal care. It addresses musculoskeletal pain, pelvic floor function and activity — within limits set by the obstetric team.

Pregnancy physiotherapy at APARC

Assessment covers where the pain is felt, which movements provoke it, pelvic floor function where relevant, and what daily activities have become difficult. Internal assessment is never automatic — it is discussed first, can be declined with treatment continuing, and a female clinician can be requested.

This sits within our women’s health physiotherapy service. For recovery after birth see our guidance on abdominal separation, and for people who cannot travel easily, home physiotherapy is available.

Carpal tunnel and other common pregnancy complaints

Numbness, tingling or pain in the hand — often worse at night — is common in pregnancy because of fluid retention increasing pressure on the median nerve at the wrist. It usually settles after birth. Night splinting, activity modification and nerve-gliding exercises are the usual measures. Persistent weakness or wasting of the hand muscles needs medical review rather than watchful waiting.

Rib pain, upper back pain and breathlessness on exertion become more common in later pregnancy as the ribcage and diaphragm are mechanically restricted. Position, breathing and thoracic mobility work usually help. Breathlessness that is sudden, severe, or associated with chest pain is not a musculoskeletal problem and needs urgent assessment.

Support belts: useful, and often used wrongly

A pelvic support belt can reduce pelvic girdle pain for some people. Two things determine whether it helps: position and duration. It sits low, around the hips at the level of the greater trochanters, not around the waist. And it is an aid for activity, not something to wear all day — continuous use encourages reliance rather than recovery.

If a belt makes symptoms worse, that is useful information, not a reason to persist.

Sleep and positioning

From the second half of pregnancy, side-lying is generally recommended, with a pillow between the knees to keep the pelvis level and reduce the rotational strain that provokes pelvic girdle pain. A pillow supporting the abdomen often helps too. Getting in and out of bed by rolling with the knees together, rather than twisting, is a small change that reduces a lot of pain.

Preparing for labour and afterwards

Physiotherapy input before birth commonly covers positions for labour, breathing and pushing technique, and what to expect of the pelvic floor afterwards. Understanding in advance what is normal in the early postnatal weeks — and what is not — makes it far more likely that problems get reported rather than tolerated.

Persistent leaking, heaviness or dragging in the vagina, or pain with intercourse at six weeks and beyond, are common but not normal, and all are assessable.

Returning to exercise after birth

Return is guided by symptoms and by the type of birth, not by a fixed date. A general principle is to progress from walking and breathing work, to low-impact strengthening, to higher-impact activity — moving on only when the current stage is comfortable and there is no leaking, heaviness or pain. After a caesarean there are additional considerations for abdominal loading.

References

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Medical disclaimer

This article is for general information and education only. It is not medical advice, diagnosis or treatment, and it is not a substitute for consultation with a qualified healthcare professional. Every person’s condition is different — any rehabilitation programme should be personalised following a proper assessment. Never disregard or delay professional medical advice because of something you have read here.

In an emergency, contact your local emergency services or go to the nearest hospital immediately.

To speak with an APARC physiotherapist, contact us or book an appointment.